NASCAR Employee Giving FormIf you are already making a donation through payroll deduction, you do not have to sign up again unless you want to change your donation amount. If you are new to the employee giving campaign, your first donation will start in January with deductions made as indicated, only one time each month or in full for the year.

First Name: Last Name:

Address:

City: Zip Code:State:

Phone: Email:

I would like to support The NASCAR Foundation through my Employee Giving donation.

Check One:

I would like to designate my gift to the United Way of Volusia/Flagler

I would like to support the Employee Engagement Program by making a MONTHLY donation of:

$5/month payroll deduction = $60/year $40/month payroll deduction = $480/year

$10/month payroll deduction = $120/year $50/month payroll deduction = $600/year

$20/month payroll deduction = $240/year $90/month payroll deduction = $1,080

$_____/month payroll deduction

MONTHLY DONATION:I hereby authorize NASCAR, hereinafter called the Company, to deduct _____________ per month from my net pay to be given to The NASCAR Foundation as a charitable contribution. This authority is to remain in full force and in effect until the Company has received written notification from me of its termination in such time and in such manner as to afford the Company a reasonable opportunity to act on it.

Print Name Sign Name

For one-time gifts and gifts by check or credit card, please turn over.

Name on Card:

Billing Address:

City: Zip Code:State:

Phone:

ONE TIME GIFTS:I hereby authorize NASCAR to deduct _____________ as a one-time deduction from my net pay to be given to The NASCAR Foundation as a charitable contribution.

Print Name Sign Name

Thank you so much for your support!

GIFTS BY CREDIT CARD:

Card Number:

CVV #: Expiration Date:

GIFTS BY CHECK:For gifts by check, please make checks payable to The NASCAR Foundation and deliver to the following address -

The NASCAR FoundationAttn: Samantha SpildeOne Daytona Blvd - 6th FloorDaytona Beach, FL 32114sspilde@nascarfoundation.org